Journal
JOURNAL OF CLINICAL MEDICINE
Volume 10, Issue 11, Pages -Publisher
MDPI
DOI: 10.3390/jcm10112263
Keywords
migraine; menstruation; menopause; migraine treatment; triptans; hormonal treatments
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Menstrual migraine and perimenopausal migraine are distinct clinical entities influenced by female reproductive milestones, with treatment options including long-acting triptans, combination therapy, and hormone treatments. Future research should focus on the interaction between female sex hormones and the mechanisms of migraine pathogenesis.
Migraine course is influenced by female reproductive milestones, including menstruation and perimenopause; menstrual migraine (MM) represents a distinct clinical entity. Increased susceptibility to migraine during menstruation and in perimenopause is probably due to fluctuations in estrogen levels. The present review provides suggestions for the treatment of MM and perimenopausal migraine. MM is characterized by long, severe, and poorly treatable headaches, for which the use of long-acting triptans and/or combined treatment with triptans and common analgesics is advisable. Short-term prophylaxis with triptans and/or estrogen treatment is another viable option in women with regular menstrual cycles or treated with combined hormonal contraceptives; conventional prevention may also be considered depending on the attack-related disability and the presence of attacks unrelated to menstruation. In women with perimenopausal migraine, hormonal treatments should aim at avoiding estrogen fluctuations. Future research on migraine treatments will benefit from the ascertainment of the interplay between female sex hormones and the mechanisms of migraine pathogenesis, including the calcitonin gene-related peptide pathway.
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